nutrition programming for mothers and their children

UNICEF’s approach to scaling up

nutrition programming for mothers and their children

2nd ACP Meeting, February 2015

Werner Schultink, Chief, Nutrition, Associate Director, Programme Division

Globally, nearly half of all child deaths are

attributable to undernutrition

Source: WHO-CHERG provisional estimates 2014

Global distribution of deaths among children under 5 by cause, 2013

~45% child deaths attributable to

undernutrition in 2011

161 million children are stunted worldwide

Note : The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of UNICEF concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. Source: UNICEF global nutrition database, 2014, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other nationally representative surveys. Data refer to the most recent year available for each country.

Globally, one in four children are stunted with highest prevalence rates occurring in sub-Saharan Africa and South Asia.

Percentage of under-fives who are moderately or severely stunted in 2013

Global decline in stunting burden and prevalence

Source: United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-World Bank Joint Child Malnutrition Estimates, 2014.

Globally, one in four children are stunted. Percentage of under-fives who are moderately or severely stunted in 2013

257

225

199

182

169 161

1990 1995 2000 2005 2010 2013 0

5

10

15

20

25

30

35

40

45

50

-

50

100

150

200

250

Pre

vale

nce

(%

)

Nu

mb

er o

f ch

ildre

n a

ffec

ted

(m

illio

ns)

Unfinished agenda of acute malnutrition

• Prevalent not only in

emergency situations

• Immediate impact on

survival

Wasting is defined as % of children aged 0 to 59 months whose weight for height is below minus two standard deviations (moderate and severe wasting) and minus three standard deviations (severe wasting) from the median of the WHO Child Growth Standards.

Wasting

Globally 51 million children are wasted

*CEE/CIS: Central and Eastern Europe and the Commonwealth of Independent States Source: United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-World Bank Joint Child Malnutrition Estimates, 2014.

Childinfo.org

Almost one-third of all wasted children live in Africa. Percentage of children under five who are wasted and severely wasted, by region, in 2013

‘Hidden hunger’

• Global estimates of anemia prevalence are 42% in pregnant women and 47% pre-school age children. (WHO, 2009)

• Severe anemia kills more than 50,000 women a year during childbirth. (Micronutrient Initiative, 2014)

• 18 million babies are born mentally impaired due to iodine deficiency each year. (Micronutrient Initiative, 2014)

• Deficiencies of vitamin A and zinc account for nearly 300,000 child deaths annually (Black et al., 2013)

Iron Folic acid Iodine

Vitamin A Zinc

Vitamin and mineral deficiencies account for over 50 million disability-adjusted

life years (DALYs) lost globally (Murray et al, 2013)

Micronutrient deficiencies

New guidance

UNICEF’s

approach to

scaling up

nutrition

programming

for mothers

and their

children

UNICEF’s conceptual framework

Several factors prompted UNICEF to update its

guidance

• Changing global nutrition landscape

Changing epidemiological profile

Triple burden (undernutrition, micronutrient deficiencies, overweight and obesity)

Inequalities

Stronger evidence base to guide programming

Consensus on:

Stunting reduction (WHA)

Causes and consequences

‘1000 days’ and early intervention

Multisectoral actions

Changing environment

Climate change and variability

High and volatile food prices

Urban migration

Population growth

Dietary shifts

Increased humanitarian crises and fragility

Stronger enabling environment

SUN movement

More unified international nutrition community

Common narrative

Strengthened institutional and budgetary commitment

Markedly improve nutrition for all children and women by creating an enabling environment that results in evidence-based, sustainable, multisectoral nutrition actions delivered at scale

Adolescent girls Women of RA

Pregnant & lactating women

Maternal nutrition (prevention of low birthweight) Infant & young child feeding

Prevention and treatment of severe acute malnutrition Micronutrient fortification and supplementation

Nutrition support for those with infectious diseases

Health, WASH, early childhood development, social protection, education, agriculture, poverty reduction

Targ

et

po

pu

lati

on

s (f

ocu

sin

g o

n t

he

m

ost

dis

adva

nta

ged

)

Nutrition-specific interventions Nutrition-sensitive approaches

Children under 2 years Children aged 2−5 years

U

NIC

EF

pro

gram

me

ac

tio

ns

Reduce micro-

nutrient deficiencies

Prevent and treat SAM

Improve nutritional

care for those with infectious

disease

Protect, promote and

support appropriate

feeding & adequate

food

Increase synergies

with health, WASH, ECD and social protection

Promote strengthened

linkages with

agriculture

Promote linkages with

health & education to

prevent childhood

obesity

UN

ICEF

’s

com

mit

me

nt

to

nu

trit

ion

UNICEF’s programmatic work in nutrition

2. PROGRESS AND CHALLENGES Evidence-based solutions exist

Food fortification

including salt iodization

Iron and folic acid or

multiple micronutrient

supplementation for

pregnant women

Intermittent (weekly)

iron and folic acid

supplementation for

reproductive-age

women

Fortified food

supplements for

undernourished

mothers

Nutrition counselling for

improved dietary intake

during pregnancy

Delayed cord clamping

Initiation of

breastfeeding within

one hour (including

colostrum)

Appropriate infant

feeding practices and

anti-retroviral therapy

for HIV-exposed infants

Exclusive breastfeeding −

counselling and lay

support on breastfeeding

through community-

based and facility-based

contacts

Control of the marketing

of breast milk substitutes

Appropriate infant

feeding practices and

anti-retroviral therapy for

HIV-exposed infants

Vitamin A

supplementation in first 8

weeks after delivery

Use of fortified foods,

micronutrients

supplementation and

home fortification with

multiple micronutrients for

undernourished women

Nutrition counselling for

improved dietary intake

during lactation

Communication for

behavioural and social

change

Timely, adequate, safe &

appropriate

complementary feeding

Continued breastfeeding

Control of the marketing of

breast milk substitutes

Appropriate infant feeding

practices and anti-retroviral

therapy for HIV-exposed

infants

Micronutrient

supplementation, including

vitamin A, zinc treatment

for diarrhea

Management of SAM

Food fortification, including

salt iodization

Home fortification with

multiple micronutrients

Zinc supplementation with

oral rehydration salts for

diarrhea treatment and

management

Adolescence

→ pregnancy Birth 0−5 months 6−23 months 24−59 months

Counselling and nutrition

advice to women of

reproductive age/adults

Communication for

behavioural and social

change to prevent

childhood obesity

Vitamin A

supplementation

Management of SAM

(and moderate acute

malnutrition)

Food fortification,

including salt iodization

Zinc supplementation

with oral rehydration

salts for diarrhea

treatment and

management

Nutrition-specific interventions across the lifecycle

Red refers to interventions of women of reproductive age and mothers.

Blue refers to interventions for young children.

Source: UNICEF, 2013

Improved availability, access

and use of locally available

foods

Increased access to primary

and secondary education for

girls

Adolescent health services

that provide access to

contraceptives and care

Promotion of hand washing

with soap and improved

water and sanitation

practices

Antenatal care, including HIV

testing and deworming

Intermittent preventative

treatment and promotion of

insecticide-treated bed nets

for pregnant women in high-

malaria areas

Social protection and safety

nets targeting vulnerable

women

Promotion of increased age

at marriage and reduced

gender discrimination and

gender-based violence

Parenting and life skills for

early childhood development

Maternity protection in

the workplace

Early childhood

development:

responsive care

Hand washing with soap

and improved water and

sanitation practices

Early childhood stimulation

and education

Improved use of locally

available foods for infants

(improved food access and

dietary diversification)

Deworming for children

Prevention and treatment

of infectious disease

Early childhood

development: responsive

care

Hand washing with soap

and improved water and

sanitation practices

Provision of healthy foods

in schools

Nutrition and physical

education in school

Deworming for school-age

children

Prevention and treatment

of infectious disease

Early childhood

development: child to child

and school readiness

Adolescence

→ pregnancy Birth 0−5 months 6−23 months 24−59 months

Kangaroo care

Support for birth

registration and

strengthening of

civil registration

systems

Nutrition-sensitive approaches across the lifecycle

Source: UNICEF, 2013

• Infant & young child feeding

• Micronutrient supplements &

fortification

• Nutritional support for those

with infectious diseases

• Health

• WASH

• ECD

Food security approaches

• Social protection




• Prevention & treatment of

SAM

• Health

• WASH

• ECD

Food security approaches



• Health

• WASH

• ECD

• Food security approaches


Infants

and

young

children

• Micronutrient

supplementation &

fortification



• Health

• WASH




• Treatment of SAM

• Health

• WASH




• Health


• WASH

Pregnant

and

lactating

women

• Micronutrient

supplementation &

fortification



• Health

• WASH

• Education


• Child protection



• Health

• WASH

• Education

• Health

• WASH

• Education



Adolescent

girls

Notes: Nutrition-specific interventions are denoted in black ink. Nutrition-sensitive approaches are denoted in blue italics. Infectious diseases include diseases such as HIV and

diseases associated with diarrhea and enteropathy. Nutritional responses to treating these diseases vary. *Prevention of intrauterine growth retardation.

Stunting Wasting Micronutrient deficiencies Overweight and obesity

• Energy & protein

supplementation

• Micronutrient supplements*



• Health

• WASH





• Health

• WASH

• Education


• Child protection




• Health

• WASH

• Early childhood

development (ECD)



Health, WASH and other multisectoral interventions to

address malnutrition

Markedly improve nutrition for all children and women by creating an enabling environment that results in evidence-based, sustainable, multisectoral nutrition actions delivered at scale

Operational

approach 6:

Strengthen

systems to

ensure effective

monitoring,

evaluation and

knowledge

management

for policy and

programming

for nutrition.

Operational

approach 5:

Foster a

community-

centred

approach that

empowers

communities

with the

knowledge and

tools to address

their own

nutrition issues.

Operational

approach 4:

Develop

human,

institutional and

organizational

capacity to

implement

contextually

relevant

nutrition

programmes.

Operational

approach 3:

Support the

scale-up of

evidence-

based,

sustainable

nutrition-

specific

interventions

and nutrition-

sensitive

programming.

Operational

approach 2:

Build

commitment,

strengthen

leadership and

strengthen

governance for

improved

nutrition.

Operational

approach 1:

Perform a

rights-based,

equity-focused

situation

analysis for

nutrition and its

determinants to

inform policy

development

and programme

design.

Reduce micro-

nutrient deficiencies

Prevent and treat SAM

Protect, promote and

support appropriate feeding & adequate

food

Increase synergies

with health, WASH, ECD and social protection

Promote strengthened linkages

with agriculture

Promote linkages with

health & education to

prevent childhood

obesity

Improve nutritional

care for those with infectious

disease

UN

ICE

F’s

co

mm

itm

en

t to

nu

trit

ion

UN

ICE

F

pro

gra

mm

e

ac

tio

ns

Notes: Green arrows illustrate that the operational approaches are interrelated.

UNICEF’s operational approaches

Looking ahead

54 countries have committed to the Scaling Up

Nutrition (SUN) movement

SUN brings together governments, civil society, donors, UN agencies, NGOs and the private sector to support scaling up nutrition-specific and nutrition-sensitive actions.

0

10

20

30

40

50

60

2010 2011 2012 2013 2014

Number of SUN countries is rising

Source: www.scalingupnutrition.org. Accessed Aug 2014.

http://www.scalingupnutrition.org/

For more information, please contact

Werner Schultink

Nutrition Section,

Programme Division,

UNICEF

United Nations Children’s Fund

3 United Nations Plaza

New York, NY 10017, USA

Tel: 212-326-7000

www.unicef.org

© United Nations Children’s Fund

September 2014

Cover photo © UNICEF/Asselin

Slide 8 © UNICEF/NIGB2010-0279/Pirozzi (wasting)

Slide 10 © UNICEF/Dean (micronutrient powders)

Slide 14 © UNICEF/NYHQ2006-2896/Pirozzi (complementary feeding)

Slide 18 © UNICEF/NYHQ2010-3063/Pirozzi (breastfeeding)

Slide 24 © UNICEF/NIGB2010-00586/Pirozzi (man and boy eating)

Slide 28 © UNICEF/Asselin (women in field)

nutrition programming for mothers and their children

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